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ND researchers pioneer ER technology

University research is giving trauma victims a greater chance of survival, according to Dr. Francis Castellino, director of Notre Dame’s W.M. Keck Center for Transgene Research.

Researchers at the Keck Center, in collaboration with trauma physicians from South Bend’s Memorial Hospital, are looking at blood coagulation, or clotting, using a thromboelastogram, a machine that breaks down how a patient’s blood coagulates, Castellino said. By using this machine in a new way, the researchers are finding out what specific blood product, such as platelets, plasma or red and white blood cells, a patient might need.

“We save lives by doing state-of-the-art early trauma care,” Castellino said. “We’re looking at blood clotting in real time at the point of care, whether that be at the bedside of the far-forward battlefield, like the front lines.”

This real time analysis leads to quicker treatment as well as specified treatment, called “goal-directed point of care therapy,” Castellino said.

Besides saving lives of trauma victims, who need treatment as fast as possible, these new groundbreaking developments in the field of coagulation research are also saving precious blood products.

“Treatments now are shooting blood into patients [instead of finding out what blood product they need],” Castellino said. “This research is taking it a step forward.”

Dr. Mark Walsh, a trauma physician at Memorial Hospital, said the goal-directed therapy is helpful in the emergency room.

“We can save blood products — we don’t want to waste them,” he said. “We can give this goal — directed blood component therapy instead of fixed ratios. We can adjust our ratios based on what the patient needs.”

The research out of Castellino’s lab is like nothing else in the nation, Walsh said. Only three to four other labs are doing any research like this in the nation.

“We would have nothing of scientific value without Castellino,” he said. “We continue to refine our parameters of treatment based in his research.”

Besides trauma benefits, the research out of this collaboration has also helped identify gene mutations in genetic coagulation disorders, according to Dr. Victoria Ploplis, the associate director for the Keck Center.

“No one has ever identified what is going on with the platelets,” she said.

The Keck Center, which has spent the last 40 years researching genetic disorders, is the lab for expertise in blood coagulation, according to Castellino. This collaborative research has identified platelet receptor mutations for several coagulation diseases, including two separate mutations with Bernard-Soulier syndrome, a defect where the platelets don’t connect to the walls of blood vessels.

The group has published two papers on this coagulation research since the beginning of the collaboration a year-and-a-half ago, and has several more waiting for publication, he said.

“These are pioneering papers,” Castellino said. “We have had major collaboration with schools like the University of Colorado Medical School.”

Also in progress is an application for a Department of Defense grant, according to Ploplis.

“We have a good chance of getting the grant because we have people at both ends of the research,” she said. “We have the scientists, and we have the physicians implementing the research into their treatments. It’s translational.”

Castellino said he hopes to see this research implemented on the battlefield.

“I can see it implemented in the military,” he said. “These machines are small, and you can have one in the field to diagnose what a victim needs.”